Provider Demographics
NPI:1972302164
Name:ATKINS, BRANDY RAY (COTA/L)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:RAY
Last Name:ATKINS
Suffix:
Gender:
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 NE 48TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507-7314
Mailing Address - Country:US
Mailing Address - Phone:580-512-1347
Mailing Address - Fax:
Practice Address - Street 1:313 NE 48TH ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73507-7314
Practice Address - Country:US
Practice Address - Phone:580-512-1347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1782224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant